Emailing nuhu-kaamel-dissertation-3_27_18.pdf - DETERMINANTS OF HEALTH-SEEKING BEHAVIOR IN GHANA By Kaamel M Nuhu B.S(Medical Sciences University of

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Unformatted text preview: DETERMINANTS OF HEALTH-SEEKING BEHAVIOR IN GHANA By Kaamel M. Nuhu B.S (Medical Sciences), University of Ghana, 2008 MD, University of Ghana, 2012 MPH, Southern Illinois University Carbondale, 2016 A Dissertation Submitted in Partial Fulfillment of the Requirements for the Doctor of Philosophy Degree in Education In the field of Health Education Department of Public Health and Recreation Professions in the Graduate School Southern Illinois University Carbondale March 2018 DISSERTATION APPROVAL DETERMINANTS OF HEALTH-SEEKING BEHAVIOR IN GHANA By Kaamel M. Nuhu A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Education In the field of Health Education Approved by: Wendi Middleton, PhD, Chair Aaron Diehr, PhD Justin McDaniel, PhD Yanyan Sheng, PhD Leonard Gadzekpo, PhD Graduate School Southern Illinois University Carbondale March 27, 2018 AN ABSTRACT OF THE DISSERTATION OF Kaamel M. Nuhu, for the Doctor of Philosophy degree in Health Education, presented on March 27, 2018 at Southern Illinois University Carbondale. TITLE: DETERMINANTS OF HEALTH-SEEKING BEHAVIOR IN GHANA MAJOR PROFESSOR: Dr. Wendi Middleton Health can be described as both a product and a process of life, and is necessary for human wellbeing, overall quality of life and productivity. While health is generally desirable, many factors affect health and health outcomes of individuals and populations the world over. Virtually all individuals will be faced with one health problem or another during their lifetime, that requires some form of health care intervention. Whatever their reasons for seeking care, all health care consumers share a common interest – a desire to get better. In a pluralistic health care environment where different avenues exist for seeking and receiving health care, differential choice of care may be influenced by sociodemographic and related factors. To the extent that the available avenues for seeking and receiving health care do not offer the same opportunities for improving health, significantly different health outcomes may be realized for comparable conditions for which different types and volume of health care are sought and received. Understanding the factors that influence health-seeking behaviors among various populations may therefore, be an important first step in designing intervention programs that nudge health consumers toward better health-seeking behaviors with the goal to improving health and health outcomes among these populations. The purpose of this research was to develop a research instrument for studying health-seeking behaviors based on the Health Belief Model, and to use the instrument to study the factors that influence/predict health-seeking behaviors among Ghanaians. I Using a convenience sample of 504 participants recruited from the Greater Accra, Ashanti, Volta and Northern Regions, analyses of the data showed that different sociodemographic characteristics such as age group, gender and health insurance status as well as selected modified constructs of the Health Belief Model such as Perceived Barriers to mainstream care, variously and collectively influence health-seeking behaviors at government and private health facilities, self-medication with herbal and pharmaceutical drugs, faith healing and care from traditional/herbal practitioners. Based on the findings of this study, the author concludes that health-seeking behaviors in Ghana are influenced by a multiplicity of factors including sociodemographic characteristics. Subsequently, recommendations for a more extensive study with a complementary qualitative enquiry are made in order to gain a more wholistic insight of the drivers of health-seeking behaviors in Ghana. II DEDICATION This dissertation is dedicated to the memory of my late son, Sunnibe Zidan Nuhu, who passed away on March 5, 2017. The many sleepless nights following your unexpected demise, found meaningful expression in the writing of this dissertation. You are forever immortalized in our hearts. ACKNOWLEDGEMENTS First and foremost, I would like to thank the almighty God, whose unending grace and favor gave me the strength through the most turbulent period in my personal life to be able to complete this dissertation. Next, I would like to thank my committee members for your priceless individual and collective contributions and support throughout this endeavor. To my chair, Dr. Wendi Middleton, thank you “elephantly” for nudging me into the program at a time I was undecided about my career path, and for “pushing” me beyond the boundaries of my comfort to give more than what I perceived to be my best every step of this journey. I also greatly appreciate your kind and encouraging words during the most difficult time in my personal life. Dr. Yanyan Sheng, thank you for permitting me to imbibe the rudiments of quantitative/research methods from under your feet. You are a gifted teacher, and statistics cannot be taught any easier! Dr. Aaron Diehr, thank you so much for the support and encouragement during this journey, and for your unparalleled attention to detail that filtered the finest details of my prospectus and contributed in no small measure to improving my writing ability. I am also very thankful for your immense contributions to my career objectives. Dr. Justin McDaniel, you have been a true blessing, and your unending contributions and support to my professional growth are greatly appreciated. Dr. Leonard Gadzekpo, thank you for believing in this cause, and for your encouragement to do something that contributes to Ghana’s health delivery system. Special III thanks to Christine Cisco (Administrative Aide, Department of Public Health and Recreation Professions) for the support and encouragement throughout my studies/work at the department. To Dr. Juliane Poock-Wallace, immediate past chair of the Department of Public Health and Recreation Professions and now Dean of the Graduate School, I am forever grateful for your massive support during my doctoral studies and professional development. My greatest appreciation also goes to my loving and supportive family, whose time I borrowed heavily in the writing of this dissertation. Special thanks to my caring and illustrious wife, Dr. (Mrs.) Genevieve Alorbi-Nuhu, for the support and encouragement every step of the way. To my son, Kaamel Nuhu Jr (KJ), thank you so much for lending me precious family time to do my “school work” as you call it. You and your mum (my wife) not only bore the brunt of this entire process, you have been my greatest inspiration and cheerleaders! I will also like to thank my “dad’’, Alhaji Mankama Nuhu and “mum”, Catherine Ama Deri, whose knees turned sore in unending prayers for my academic and professional success. “Mum”, thank you for the many sacrifices that fed my dreams and made them possible. Many thanks to my parents-in-law, Mr. Rex Alorbi and Mrs. Cynthia Holm-Alorbi for the support and encouragement during the pilot testing and throughout this journey. To all my siblings, thank you for the love and support over the years. Special thanks to Mujeeb Nuhu for the support to the research assistants during the data collection in the Northern Region. Additional thanks go to my classmates - Eric, Eva, Kombe, Mohammed and Amber for the friendship and thorough discussions during my coursework. To my team of trained research assistants (Mike and colleagues) and community volunteers, thank you for making the data collection process less stressful. Finally, I will like to thank the 504 participants, who volunteered to participate in this study, and invested valuable time in the completion of the IV surveys. Your contributions form what I hope will be the first step of graduated efforts to improve health-seeking behaviors for all health care consumers in Ghana. V TABLE OF CONTENTS CHAPTER PAGE ABSTRACT. ................................................................................................................................... i DEDICATION ............................................................................................................................... iii ACKNOWLEDGEMENTS ........................................................................................................... iii LIST OF TABLES. ........................................................................................................................ xi CHAPTERS CHAPTER 1 – Introduction….................................................................................1 Introduction…..........................................................................................1 Morbidity and Mortality in Ghana...........................................................2 Options for Health care in Ghana.............................................................2 Statement of the Problem..........................................................................6 Need for the Study…................................................................................8 Purpose of the Study….............................................................................9 Research Questions….............................................................................10 Significance to Health Education............................................................10 Research Method….................................................................................12 Instrument… ...........................................................................................12 Sample and Participant Selection.............................................................13 Theoretical Framework............................................................................13 Assumptions…........................................................................................14 Limitations..............................................................................................15 Delimitations….......................................................................................15 VI Definition of Terms...............................................................................16 Summary................................................................................................17 CHAPTER 2 – Literature Review........................................................................18 Introduction….......................................................................................18 Purpose of Study...................................................................................18 Background of the Problem..................................................................19 Profile of Ghana.................................................................19 Health and Health Outcome….............................................................21 Introduction…....................................................................21 Determinants of Health and Health Outcomes...................22 Avenues for Seeking Health care.........................................................26 The Health-Seeking Process and Stages in Health-Seeking….............28 Determinants of Health-Seeking Behavior...........................................30 Modern Medicine/Primary Care...........................................................35 Introduction..........................................................................................35 Primary Care….....................................................................................36 Modern Medicine/Primary Care and Health Outcomes..37 Factors Affecting Primary Care Utilization…................38 Primary Care in Ghana...................................................40 Self-Medication….................................................................................43 Introduction….......................................................................................43 Self-Medication and Health Outcomes….............................................44 Determinants of Self-Medication…......................................................45 VII Self-Medication in Ghana…................................................................48 Traditional/Herbal Medicine…............................................................49 Introduction…......................................................................................49 Traditional/Herbal Medicine and Health Outcomes….........................50 Determinants of Traditional/Herbal Medicine….................................51 Traditional/Herbal Medicine in Ghana…............................................56 Faith Healing…...................................................................................57 Introduction….....................................................................................57 Faith Healing and Health Outcomes...................................................57 Determinants of Faith Healing…........................................................58 Faith Healing in Ghana…...................................................................60 Theoretical Framework.......................................................................61 Health Belief Model.................................................... 62 Summary............................................................................................63 CHAPTER 3 – Methods ........................................................................... 65 Introduction…...................................................................................65 Purpose of the Study….....................................................................65 Significance to Health Education….................................................65 Quantitative Design…......................................................................66 Research Questions and Hypotheses…............................................66 Research Method…..........................................................................69 Operationalization of Study Variables.............................................70 Study Sample and Participant Selection… .......................................73 VIII Sample Size Estimation…................................................................74 Data Collection….............................................................................75 Instrumentation….............................................................................77 Pilot Study........................................................................................78 Demographic Characteristics of Pilot Participants...80 Reliability of the Instrument.....................................81 Validity of the Instrument.........................................83 Health-Seeking Behaviors among Pilot Group…..100 Data Analysis….............................................................................101 Summary.........................................................................................103 CHAPTER 4 – Results............................................................................104 Introduction...................................................................................104 Purpose of Study….......................................................................104 Research Questions.......................................................................105 Demographic Characteristics of Study Participants.....................105 Instrument Validity......................................................................107 Instrument Reliability..................................................................118 Results of Analysis for Research Questions................................120 Results for Research Question 1.........................120 Results for Research Question 2.........................121 Results for Research Question 3.........................128 Results for Research Question 4.........................130 Results for Research Question 5.........................134 IX Summary..................................................................................138 CHAPTER 5 – Discussion, Recommendations and Conclusions……140 Introduction…........................................................................140 Demographic Characteristics of Study Participants...............140 Discussion of Results from Research Question O ..................141 Discussion of Results from Research Question Two .............143 Discussion of Results from Research Question Three ...........151 Discussion of Results from Research Question Four .............153 Discussion of Results from Research Question Five .............157 Limitations of the Study.........................................................158 Recommendations for Future Research.................................159 Contributions and Implications for Health Education………160 Conclusions.............................................................................162 REFERENCES…..............................................................................165 APPENDICES…...............................................................................186 APPENDIX A – Approval for Pilot Study…..........................187 APPENDIX B – Approval for Main Study….........................188 APPENDIX C – Cover Letter for Consent.............................189 APPENDIX D – Original Survey Instrument.........................190 APPENDIX E – Revised Survey Instrument..........................203 VITA.................................................................................................213 X LIST OF TABLES Table 1 - Dependent Variable, Independent Variables and Levels of Measure Table 2 - Number of Ghanaians aged 18 years and older in the Greater Accra, Volta, Ashanti and Northern Regions of Ghana Table 3 - Demographic Characteristics of Pilot Participants Table 4 - Results for Reliability Analysis of Pilot Study Table 5 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Health-Seeking Behaviors at Government Health Facility Table 6 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Health-Seeking Behaviors at Private Health Facility Table 7 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Health-Seeking Behaviors using Self-Medication with Herbal Drugs Table – 8 Pilot Study Factor Loadings for PCA with Varimax Rotation of Health-Seeking Behaviors using Self-Medication with Pharmaceutical Drugs Table 9 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Health-Seeking Behaviors from Traditional/Herbal Practitioners Table 10 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Health-Seeking Behaviors from Faith Healers Table 11 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Severity of Last Illness Table 12 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Susceptibility to Illness XI Table 13 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Benefits of Seeking Healthcare at Government Health Facilities Table 14 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Benefits of Healthcare at Private Health Facilities Table 15 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Benefits of Self-Medication with Herbal Drugs Table 16 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Benefits of Self-Medication with Pharmaceutical Drugs Table 17 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Benefits of Seeking Healthcare from Traditional/Herbal Practitioners Table 18 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Benefits of Seeking Healthcare from a Faith Healer Table 19 - Pilot Study Factor Loadings for PCA with Varimax Rotation of Perceived Barriers to Seeking Healthcare from a Government Health Facility Table 20 - Pilot Study Factor Loadings for PCA with Varimax Rotati...
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